Every case of developed paranoia should be under custody and control until such time as the stage of transfor mation occurs. Henry M. Hurd (Nash ville Jour. of Med. and Surg., May, '96).
Diagnosis.—The history of a neuro pathic ancestry, the slow development, the persistent character of hallucinations and delusions, with the comparatively slight degree and late appearance of de mentia differentiate paranoia from other forms of insanity. At times moderate grades of imbecility may simulate para noia, but careful observation for a time will usually permit a definite diagnosis.
Four cases of chronic paranoia, show ing degeneration of posterior cords of spinal marrow. Alterations of spinal cord in relation with psychical troubles of paranoia. Bernhard Feist (Virchow's Archiv, B. 13S, H. 3, '95).
Prognosis.—As stated in the definition, paranoia is incurable. Krafft-Ebing says that in over one thousand cases under personal observation not a single recovery resulted. Remissions, and prolonged in termissions for a year or more may occur. These may be true lucid intervals with disappearance of all symptoms, but should not be regarded as permanent re coveries.
The duration of life is not shortened by paranoia. Dementia is not likely to occur until late stages, and then usually only to a moderate degree. Slightly marked weak-mindedness is, however, not unusual.
Treatment.—The paranoiac is always potentially a dangerous character, and hence requires to be kept under observa tion when the diagnosis is established. The restriction of a person's liberty is not to be lightly advised, but the advice is rarely improper in this form of insanity. The paranoiac is usually much better in an institution for the insane than when at large. His hallucinations and delu sions become less disturbing, and he is largely deprived of the power of mischief. There are no "harmless cranks." They may be too cowardly to commit overt acts, but the fact that most of these characters when admitted to hospitals are armed with loaded revolvers or other concealed weapons is an indication of the trend of their thoughts. In all cases of paranoia the patient should be placed under strict observation and control. There is no other safe treatment.
The paranoiac is a menace to society and should be sequestrated. C. B. Burr (Medicine, Nov., '95).
Recurrent Insanity.
Definition.—Recurrent or periodic in sanity appears as states of exaltation (mania), depression (melancholia), or an alternation of the two (circular insanity), with intervals of apparent lucidity. Peri odic dipsomania is one form of recurrent insanity. The tendency to recur persists
throughout life, and dementia is rare.
Recurrent Mania.— SYMPTOMS.—The essential feature of recurrent mania is the occurrence of exaltation of feelings with out confusion of ideas. The usual symp toms of mania (q. v.) probably dependent upon cerebral hyperemia come on often without any prodroinic symptoms of de pression. After a month or longer in the exalted stage, the patient gradually, sometimes suddenly, returns to his nor mal mental condition, which, however, is not to be mistaken for recovery. The victim of periodic insanity exhibits even in the intervals evidences of some in volvement of the intellectual functions. The inherited tendency to mental dis turbance is always discoverable.
[I recall a well marked case in a phy sician of about 55 years of age. He had been insane five or six times before. The first symptoms of an attack were neglect of his patients and an exceptional in terest in the religious life of his neigh bors. He talked religion and dialectics to anyone who would listen to him. As the malady advanced he began to regard himself as a fountain of medical knowl edge, capable of filling any chair in any college to which he might be called. He had proposed himself for any vacancy that might occur in one of the medical colleges of Baltimore. The branch to be taught did not matter to him; he was equally competent in all. GEORGE H. ROHE.] During the attack there is usually some loss of weight. The first attack most frequently occurs at puberty. In women succeeding attacks often coincide with the menstrual period.
Psychical integrity of women during their menses is a question most useful to consider in legal medicine. It appears expedient to find out if the crime com mitted by the prisoner coincided with her menstrual period. Under the term "period" is included not only the days during which the blood comes away, but those that precede and follow it.
An examination of the mental condi tion should be advised when the criminal act coincides with this period. This ex amination is indispensable when the his tory of the patient reveals a neuropathic taint or the existence of mental trouble during former menstrual periods, or when the act itself discloses peculiar changes.
When it is evident that the menstrual process exercised a powerful influence on the mental life of subject, she should have the benefit of this fact, even if no menstrual insanity can be made out in what concerns the application of the law in the given case. Krafft-Ebing (Jahr buch fiir Psych., vol. x; Annals of Gyn. and Ped., June, '94).